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Gamma Knife Radiosurgery for Uveal Melanomas and Metastases: A Systematic Review and Meta-Analysis
26 Pages Posted: 7 Jul 2020
More...Abstract
Background: Uveal melanomas and secondary ocular metastases can be effectively treated by globe-sparing therapies including brachytherapy, transpupillary thermotherapy and stereotactic radiosurgery (SRS). Gamma knife radiosurgery (GKRS) is widely regarded as the gold standard SRS modality for the treatment of intracranial tumors, and its applicability has been expanded for the treatment of intraocular malignancies.
Objective: To evaluate the clinical outcomes of gamma knife radiosurgery in the treatment of uveal melanoma and intraocular metastases.
Methods: A systematic review was performed to aggregate the clinical outcomes of patients with uveal melanomas or intraocular metastases treated primarily with GKRS. Data regarding local tumor control, tumor regression, secondary enucleations, post-treatment visual acuity and adverse outcomes were extracted and quantitatively analyzed.
Results: Based on the pooled analysis of 28 studies, local tumor control was achieved in 95.6% of patients (95% CI, 92.8% - 97.8%; I2 = 42.1%), while 81.8% of patients experienced tumor regression (95% CI, 71.0% - 90.8%; I2 = 81.0%). 26.7% of patients reported stable or improved visual acuity post-GKRS (95% CI, 16.2% - 38.6%; I2 = 83.9%) and 5.4% of patients (95% confidence interval [CI], 3.8% - 7.3%; I2 = 0%) underwent secondary enucleations due to treatment failure. Pooled estimates demonstrated a 3-year and 5-year survival rate of 94% and 74% respectively, with an expected likelihood of post-GKRS complications estimated at 31.8% (95% CI, 22.1% - 42.3%; I2 = 88.4%).
Conclusion: GKRS is an effective method of primarily treating uveal melanomas and ocular metastases, with comparable tumor control to other globe-preserving therapies.
Funding Statement: This work was funded in part by the Rhodes Trust and the Howard Brain Sciences Foundation.
Declaration of Interests: The authors have no relevant conflicts of interest to disclose.
Keywords: gamma knife radiosurgery; stereotactic radiosurgery; uveal melanoma; ocular metastases
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